Remote Utilization Review Nurse I

CorVel Corporation; Rancho Cucamonga, Northern (CA, KY); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

401K

Paid time off

Job summary

CorVel Corporation is seeking a Utilization Review Nurse to gather demographic and clinical information for prospective, concurrent, and retrospective reviews of in-patient admissions and outpatient treatment, certifying medical necessity and assigning length of stay in line with Case Management goals.

This is a remote position with responsibilities including data collection, decision-making on certification/denial, documentation, stakeholder engagement, and adherence to safety programs.

Qualifications

• Graduate of an accredited nursing program with RN licensure.
• Current nursing licensure in the state of operation; LVN/LPN allowed where permitted.
• 4+ years of recent clinical experience with utilization review preferred.

Responsibilities

• Identify necessity of the review and communicate concerns to claims staff.
• Collect data and analyze information to certify or deny treatment.
• Document all work in the appropriate manner.
• Promote utilization review services with stakeholders.
• Comply with safety rules during work hours under IIPP; perform additional duties as assigned.

Skills

CPT/ICD coding

Interfacing with staff

Organization

Time management

Communication

MS Office

Workers' comp knowledge

Utilization review

Education

RN license (CA) or LVN/LPN where allowed

ASN/BSN degree

BSN preferred

Tools

Microsoft Office Suite

Job description

CorVel Corporation is seeking a Utilization Review Nurse to gather demographic and clinical information for prospective, concurrent, and retrospective reviews of in-patient admissions and outpatient treatment, certifying medical necessity and assigning length of stay in line with Case Management goals.

This is a remote position with responsibilities including data collection, decision-making on certification/denial, documentation, stakeholder engagement, and adherence to safety programs.